Health care showdown this week for Bush, Congress

c Clatchy Newspapers

WASHINGTON - The Democratic-controlled Congress this week will move one step closer to a showdown with President Bush over the future of children's health insurance.

Both the House of Representatives and the Senate are expected to vote on bills to expand the State Children's Health Insurance Program, or SCHIP. The 10-year-old program covers children whose families earn too much to qualify for Medicaid, but not enough to afford private health insurance.

Bush and many GOP leaders oppose the expansions, claiming they cast too wide a net and would be a step toward "government-run health care."

Speaking to a crowd in Cleveland, Ohio, earlier this month, Bush said the expanded programs would prompt families that can afford private health insurance to opt instead for government-funded coverage.

"I strongly object to the government providing incentives for people to leave private medicine. ... "I think it's wrong and I think it's a mistake. And therefore, I will resist Congress' attempt to federalize medicine."

Bush has threatened to veto the bipartisan Senate proposal, which would increase the program's funding by $35 billion over five years. The House bill, crafted solely by Democrats, calls for a $50 billion increase over the same period.

The SCHIP program now costs $5 billion a year, or $25 billion over five years. An additional $2.8 billion a year, $14 billion over five years, is needed just to maintain current service levels, according to the bipartisan Congressional Budget Office.

Bush wants to expand the program by $1 billion a year, about 36 percent of what the CBO says is needed to preserve services.

The president's opposition to expanding the program is an ideological line in the sand against growing calls for universal health care. But that position could prove tricky for Republicans who don't want to be tagged as opposing health care for children on the eve of an election year.

The SCHIP program was established in 1997 to help cover children whose families earned up to twice the federal poverty level. In 2007, that's the equivalent of $41,300 for a family of four, according to the Kaiser Family Foundation.

Over its first 10 years, the SCHIP program and Medicaid, the state-federal health program for the poor, have helped to reduce the percentage of low-­income children who lack health insurance by about a third.

But some 9 million youngsters are still without health coverage, and Democrats say that expanding the SCHIP program would address the problem because research indicates that most uninsured children are eligible for, but not enrolled in, Medicaid or SCHIP.

Both the House and Senate are expected to vote on the proposals before Congress adjourns this week for its summer recess. The program will expire if it isn't reauthorized by Sept. 30, leaving states with no federal funds to help cover the program's 6 ­million-plus children.

"If we fail to pass this bill, 6 million children will lose their health care coverage as of October," said Rep. John Dingell, D-Mich., who helped draft the House bill.

The House proposal, dubbed the Children's Health and Medicare Protection Act, would increase SCHIP funding by $50 billion over five years, to a total of $75 billion. Five million more uninsured children would receive coverage under the proposal, which would also spend $15 billion on Medicare-related services.

The Senate proposal would increase the program's funding by $35 billion over five years and raise total spending to $60 billion. More than 3 million additional uninsured children would receive coverage under the bipartisan proposal.

Both the House and Senate bills would be funded by increased taxes on cigarettes and other tobacco products and payment cuts to insurers in the Medicare Advantage program.

Sen. Orrin Hatch, R-Utah, who supports the Senate proposal, said he believes that the White House probably would be amenable to another $4 billion to $9 billion in total funding. But he said such small increases are "a far cry from reality."

"You can't just ignore that there are millions of kids that might not be covered, and frankly, it's penny-wise and pound-foolish not to help kids" get adequate health care, Hatch said.